Grant: Project Grant

While reversing overdoses with medications like naloxone is a cornerstone of the response to the opioid public health emergency, preventing overdoses through the development of effective treatments for opioid use disorder (OUD) is critical to addressing this epidemic. Unfortunately, in Canada, there are only two proven life-saving treatments: buprenorphine/naloxone (BNX) and methadone. However, these medications have limitations and are not acceptable for many individuals, resulting in a substantial proportion of individuals who remained untreated and at immediate risk of overdose, death and other negative outcomes. Small European studies suggest that slow-release oral morphine (SROM) may be another potentially effective treatment that is better tolerated, and is associated with greater patient satisfaction and reductions in craving compared to methadone. The goal of the proposed research is to build on these encouraging results and rigorously evaluate the relative effectiveness, safety and acceptability of SROM and methadone in real-life clinical settings in Canada. To that end, we will enrol approximately 200 adults with OUD, who are currently exposed to fentanyl, and who have tried but not benefited from treatment with BNX. Eligible participants will be randomized to receive either methadone or SROM for approximately six months, using a double-blind design where neither participants nor their physicians will know which medication they are receiving. Findings from this study will greatly increase our knowledge of the relative benefits of different treatment alternatives for OUD, and how each of them may suit different individuals' needs. Importantly, from a health policy perspective, positive results confirming SROM clinical utility could present significant potential to increase access to an additional form of evidence-based treatment for OUD in Canada, with potential to be scaled up rapidly given that SROM is already available as an inexpensive generic drug.